MULTICOVER EXTRAS BENEFITS RANGE FROM - TO
LIMITS PER PERSON PER CALENDAR YEAR
$32 – $55
2 services/1 service
$28
Service limits apply
$36 – $62
2 services
$27
1 service
Metallic and tooth coloured (direct)
$80 – $174
$550
Surgical extractions
$165 – $250
Oral surgery
Simple extractions
$90 – $130
Occlusal therapy
$35 – $250
Endodontic Services
Treatment of root canals
$48 – $264
Periodontic Services
Treatment of tissue surrounding the teeth
$20 – $281
Dentures and components (partial and complete)
$20 – $800
Maintenance and repair
$22 – $120
$120
Crowns and bridges
Preparation and placing of crowns and bridges
$50 – $635
$800
Orthodontics
Accrues at $440 per year up to $2,640 maximum lifetime limit for Orthodontist or $1,000 for General Dentist treatment. Sub-limits apply.
SERVICE CATEGORY
Diagnostic dental Preventative dental
DENTAL
Fillings
OPTICAL
Dentures
DESCRIPTION
Examinations – general dentist/specialist dentist Single film x-rays Removal of plaque/calculus Application of fluoride
Spectacle frames Glasses and contact lenses
$92 – $180
Contact lenses – pair
$116 – $220
Psychology (after Medicare entitlement is exhausted)
$75 per visit
THERAPIES
$300
$45/$35
$300
Podiatry consultation (cannot be used for in-patient services)
$33/$25
$200
Audiology
$52/$35
Speech pathology
$60/$40
$500 Max $200 for Audiology
$62/$40
$500
Chiropractic First/subsequent visits Osteopathy (unless otherwise specified)
$35 visits 1 – 2/$29 visits 3 – 11/$14 visits 12+
Exercise Physiology
$600 - $1,000* Sublimit of $375 each for Chiropractic, Osteopathy and Exercise Physiology
$30/$28 $45 visits 1 – 2/$32 visits 3 – 11/$17 visits 12+
$600 - $1,200#
Acupuncture/Chinese Herbal Medicine consultation (CHM)
$30/$17
$200 Max $100 CHM
Remedial Massage/Myotherapy
$30/$17
Physiotherapy
Naturopathy/Nutrition consultation
$30/$17
Alexander Technique
$27/$20
Homoeopathy
OTHER SERVICES
$220
Dietetics
$32 visits 1 – 2/$28 visits 3 – 11/$14 visits 12+
Minimum 200km+ return trip for medical/hospital treatment when not available locally
HCF approved Pharmacy
After PBS equivalent co-payment subtracted
Artificial aids
HCF approved appliances
Hearing aids
Benefits accrue over time and renew every 3 years
Health Management Programs School Accident Cover
* Accrues at $100 per year, up to $1,000. # Accrues at $120 per year, up to $1,200.
$800 every 3 years
$85
Spectacle lenses – pair
Occupational Therapy
Travel & Accommodation
$500
$200
$27/$17 Up to $100 per trip per membership ($30 per night for accommodation)
$400 for travel (includes $200 sublimit for accommodation)
Up to $50 per script
$600
$25 – $500
$500
Up to $1,600
$600 – $1,600
HCF approved – single/couples or family
Up to $150
$150/$300
Approved ancillary services only
Up to $800
$800
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THINGS YOU NEED TO KNOW The following waiting periods apply where these services are covered under your policy: EXTRAS WAITING PERIODS 1 DAY
Emergency ambulance (where not for pre-existing ailments).
2 MONTHS
HCF Health Management Programs and approved HCF Disease Management Programs.
12 MONTHS
Crowns, bridges, dentures, endodontics, occlusal therapy, surgical extractions, oral surgery, complex fillings, periodontics, prosthodontics, dental bleaching, veneers, orthodontics, artificial aids, foot orthotics and hearing aids.
2 MONTHS
All other extras services and Non-Emergency Ambulance (where not for pre-existing ailments).
WHAT’S NOT COVERED? There are a number of situations where our health insurance doesn’t cover you:
HCF Health Insurance does not cover: • If a Service is listed as an excluded service (regardless of whether required as a result of an Accident) in the Product Information (as defined in the Fund Rules); • Claims made 2 years or more after date of Service; • Elective Cosmetic Surgery on most levels of cover; • When a Member has the right to recover the costs from a third party other than HCF, including an authority, another insurer or under an employee benefit scheme; • Treatment for Pre-Existing Conditions (other than for psychiatric rehabilitation or palliative care) within the 12 month Waiting Period (the Pre-Existing Condition Waiting Period applies to new Members and Members upgrading their Policy to any higher level Benefits under their New Policy); • Services received during any period where payment is in arrears, the Policy is not financial, the Policy is suspended or within a Waiting Period; • Treatment that HCF deems to be inappropriate or not reasonable, after receiving independent medical or clinical advice; • Any Service where the Treatment does not meet the standards in the Private Health Insurance (Accreditation) Rules; • Emergency room fees; • Services that are not delivered face to face, such as online or telephone consultations, unless a Member is participating in a Chronic Disease Management Program or Health Management Program; • Services supplied by a provider not recognised by HCF; • Services provided outside Australia which do not meet the requirements under the Private Health Insurance Act; • Ambulance transfers between hospitals (emergency or non-emergency); or • Claims that do not meet HCF’s criteria as set out in the Fund Rules.
• Where no specific health condition is being treated or in the absence of symptoms, illness or injury; • Routine health checks, screening and mass immunisations; • More than one therapy Service performed by the same provider in any one day; • Where a provider is not in an independent Private Practice; • Add-ons for optical such as high index material, coatings and tinting. Our list of HCF Participating Private Hospitals, no-gap providers, approved pharmacy items and artificial aids and appliances are subject to change and updated regularly. If your cover includes any of these items and you wish to make a claim, please call us on 13 13 34 to confirm your benefits.
Ambulance cover When Benefits are payable, no limit for Emergency Ambulance Transport and up to $5,000 per person per Calendar Year for medically necessary Non-Emergency Ambulance Transport. Benefits only payable for Tas residents when not covered under their state ambulance service scheme and for Vic, SA, NT and WA residents when an ambulance subscription with the relevant state ambulance service is not held. HCF does not pay Benefits for Qld residents for both Emergency and Non-Emergency Ambulance Transport. Eligibility for Benefits is in accordance with the Fund Rules.
Note: This is not a comprehensive list of items covered under your extras cover. Please call 13 13 34 to check what you’re covered for prior to treatment.
In addition, HCF extras cover does not include: • Psychological and developmental assessments; • Co-payments and gaps for government funded health services including the co-payment for PBS items; • Psychology treatment (where included under a Policy) unless a mental health plan has been prescribed under Medicare entitlements and these entitlements have been exhausted for the calendar year; • Services while a Hospital patient except for eligible oral surgery; • Pharmacy items that are not on HCF’s approved pharmacy list including items listed on the PBS, items prescribed without an illness, items that are available without a prescription, items supplied by a Hospital as take home drugs, or items that are not approved by the TGA; • Services that had not been provided at time of claim; • Fees for completing claim forms and/or reports; • Services received overseas or purchased from overseas including items sourced over the internet;
Multicover Extras PS 0118. This document is current at January 2018 and may be superseded at any time. This product summary is created from the Fund Rules.
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